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Medical billing, coding, denials, credentialing, PCMH and practice operations, written to be useful on Monday morning.
How to Prepare a Charge Master for the October and January Code Changes
Two code updates hit within 90 days: ICD-10-CM on October 1 and CPT and HCPCS on January 1. Here is the step-by-step process we use to update fee schedules, superbills, charge rules and EHR favorites so the first claims of each period don't reject, with a worked example and the mistakes that repeat every year.
AMA Releases CPT 2025: 17 New Telemedicine Codes to Load Before January 1
The CPT 2025 code set is out with 270 new codes, 112 deletions and 38 revisions effective January 1, 2025. The headline is a new telemedicine E/M family, 98000 to 98016, and the deletion of the telephone codes 99441 to 99443. Here is what changes, what payers have not said yet, and the setup work for the fall.
PCMH Annual Reporting for 2025: What to Start Collecting This Fall
NCQA's 2025 Annual Reporting requirements change the eCQM list, add HIV measures, require a diversity report and tighten care plan and clinical advice evidence. Here is what changed, what to pull from the EHR now, and the mistakes that turn a routine check-in into a corrective action plan.
FTC Noncompete Rule Set Aside: What It Means for Physician Employment Agreements
On August 20, a federal judge in Texas set aside the FTC's nationwide ban on noncompete agreements, two weeks before it would have taken effect. For medical practices, that means noncompetes remain a matter of state law. Here is what changed, what did not, and the departure checklist that matters more.
UnitedHealthcare's Gold Card Program: Tracking Prior Authorizations to Qualify
UnitedHealthcare announced a national Gold Card program on August 1, effective October 1, 2024, that exempts qualifying groups from prior authorization on selected codes. Qualifying depends on a two-year approval rate the payer calculates. What it requires, how the math works, and the tracking that gets you there.
How to Build a Denial Dashboard Your Practice Will Actually Use Every Week
Most practices have denial reports nobody reads. A denial dashboard is different: eight fields captured on every denial, six numbers reviewed weekly, and a category scheme that points at the process that failed. Here is how to build one in a spreadsheet, with a worked example, before you buy software.
Billing Medicare Annual Wellness Visits (G0438, G0439) Without the Usual Denials
The annual wellness visit is one of the few Medicare services with no patient cost sharing, and one of the most frequently denied. Here is how the IPPE, first AWV and subsequent AWV fit together, what documentation each requires, how to add a problem visit with modifier 25, and the denials to prevent.
FY2025 ICD-10-CM Update: 252 New Codes to Prepare for Before October 1, 2024
CMS posted the FY2025 ICD-10-CM code set on July 3: 252 new codes, 36 deletions and 13 revisions, effective for dates of service on or after October 1, 2024. Here is what is in it for office practices, and the ten-week plan for updating templates, superbills, scrubber edits and staff before the switch.
CY2025 Physician Fee Schedule Proposed Rule: What the 2.8% Cut Means
CMS released the CY2025 Physician Fee Schedule proposed rule on July 10: a conversion factor of $32.36, down 2.8% from $33.29, new Advanced Primary Care Management codes, and telehealth proposals that depend partly on Congress. Here is what changes, who it affects and how to model it on your own code mix.
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